Which sign is an early indication that a client has developed hypocalcemia?
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In neonates, hypocalcemia is more likely to occur in infants born of diabetic or preeclamptic mothers. Hypocalcemia also may occur in infants born to mothers with hyperparathyroidism. Show Clinically evident hypocalcemia generally presents in milder forms and is usually the result of a chronic disease state. In emergency department patients, chronic or subacute complaints secondary to mild or moderate hypocalcemia are more likely to be a chief complaint than severe symptomatic hypocalcemia. Once laboratory results demonstrate hypocalcemia, the first question is whether the hypocalcemia is true—that is, whether it is representative of a decrease in ionized calcium. The presence of chronic diarrhea or intestinal disease (eg, Crohn disease, sprue, chronic pancreatitis) suggests the possibility of hypocalcemia due to malabsorption of calcium and/or vitamin D. The patient's past medical history should be explored for pancreatitis, anxiety disorders, kidney or liver failure, gastrointestinal disorders, and hyperthyroidism or hyperparathyroidism. Previous neck surgery suggests hypoparathyroidism; a history of seizures suggests hypocalcemia secondary to anticonvulsants. The patient may have a recent history of thyroid, parathyroid, or bowel surgeries or recent neck trauma. The length of time that a disorder is present is an important clue. Hypoparathyroidism and pseudohypoparathyroidism are lifelong disorders. Instead, acute transient hypocalcemia may be associated with acute gastrointestinal illness, nutritional deficiency, or acute or chronic renal failure. In an elderly patient, a nutritional deficiency may be associated with a low intake of vitamin D. A history of alcoholism can help diagnose hypocalcemia due to magnesium deficiency, malabsorption, or chronic pancreatitis. Inquire about recent use of drugs associated with hypocalcemia, including the following:
Other considerations in the history include the following:
Acute hypocalcemia may lead to syncope, chronic heart failure (CHF), and angina due to the multiple cardiovascular effects. [38] Neuromuscular and neurologic symptoms may also occur. [39] Neuromuscular symptoms include the following [40] :
Neurologic symptoms of hypocalcemia include the following [41] :
Chronic hypocalcemia may produce the following dermatologic manifestations:
 Next: Physical ExaminationNeuromuscular and cardiovascular findings predominate. Neural hyperexcitability due to acute hypocalcemia causes smooth and skeletal muscle contractions. In addition, patients may appear confused or disoriented and may exhibit signs of dementia or overt psychosis. Irritability, confusion, hallucinations, dementia, extrapyramidal manifestations, and seizures may occur. On head and neck examination, the hair may appear coarse, and alopecia may be present. Signs of recent trauma or of surgery of the neck (eg, scars over the thyroid region) should be noted. Perioral anesthesia may be present, and adults with chronic (since childhood) hypocalcemia may be at an increased risk for dental caries and enamel hypoplasia. On eye examination, subcapsular cataracts or papilledema may be seen. On respiratory examination, inspiratory or expiratory wheezes may be present. Smooth muscle contraction may lead to laryngeal stridor, dysphagia, and bronchospasm. On cardiac examination, bradycardia, tachycardia, S3, and signs of heart failure may be present. [42] Dry skin or patches of psoriasis and eczema may be present, particularly in patients with chronic hypocalcemia. Excoriations as a result of pruritus may be noted. Test for Chvostek sign by tapping the skin over the facial nerve about 2 cm anterior to the external auditory meatus. Ipsilateral contraction of the facial muscles is a positive sign. Depending on the calcium level, a graded response will occur: twitching first at the angle of the mouth, then by the nose, the eye, and the facial muscles. Up to 10% of the population will have a positive Chvostek sign in the absence of hypocalcemia; thus, this test, while suggestive, is not diagnostic of hypocalcemia. Test for the Trousseau sign by placing a blood pressure cuff on the patient’s arm and inflating to 20 mm Hg above systolic blood pressure for 3-5 minutes. This increases the irritability of the nerves, and a flexion of the wrist and metacarpal phalangeal joints can be observed with extension of the interphalangeal joints and adduction of the thumb (carpal spasm). The Trousseau sign is more specific than the Chvostek sign but has incomplete sensitivity. Movement abnormalities associated with hypocalcemia include the following:
Peripheral nervous system findings include tetany, focal numbness, and muscle spasms. Smooth muscle contraction causes biliary colic, intestinal colic, and dysphagia. Seizures often occur in individuals with preexistent epileptic foci when the excitation threshold is lowered. Previous Differential Diagnoses
References
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of 1 Tables Back to List Contributor Information and Disclosures Author Manish Suneja, MD, FASN, FACP Professor of Internal Medicine, Director, Internal Medicine Residency Program, Co-Strand Director, Clinical and Professional Skills, Dr William and Sondra Myers Professor, Department of Internal Medicine, Division of Nephrology, University of Iowa Hospitals and Clinics Specialty Editor Board Eleanor Lederer, MD, FASN Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital Chief Editor Vecihi Batuman, MD, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Interim Chair, Deming Department of Medicine, Tulane University School of Medicine Additional Contributors Heather A Muster, MD, MS Medical Director, Davita Clinical Research Acknowledgements Jeffrey L Arnold, MD, FACEP Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians Disclosure: Nothing to disclose. Christopher B Beach, MD, FACEP, FAAEM Associate Professor and Vice Chair of Emergency Medicine, Department of Emergency Medicine, Associate Professor of Institute for Healthcare Studies, Institute for Patient Safety, Feinberg School of Medicine, Northwestern University Christopher B Beach, MD, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Robin R Hemphill, MD, MPH Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Eleanor Lederer, MD Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital Eleanor Lederer, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation, and Phi Beta Kappa Disclosure: Dept of Veterans Affairs Grant/research funds Research James W Lohr, MD Professor, Department of Internal Medicine, Division of Nephrology, Fellowship Program Director, University of Buffalo State University of New York School of Medicine and Biomedical Sciences James W Lohr, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Nephrology, and Central Society for Clinical Research Disclosure: Genzyme Honoraria Speaking and teaching Alfredo A Pegoraro, MD Consulting Staff, Nephrology Associates Alfredo A Pegoraro, MD is a member of the following medical societies: American Medical Assocation, American Society of Nephrology, and International Society of Nephrology Disclosure: Nothing to disclose. Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference What is the first sign of hypocalcemia?The hallmark of acute hypocalcemia is neuromuscular irritability. Patients often complain of numbness and tingling in their fingertips, toes, and the perioral region. Paresthesias of the extremities may occur, along with fatigue and anxiety. Muscle cramps can be very painful and progress to carpal spasm or tetany.
Which of the following are signs and symptoms of hypocalcemia?Some of the symptoms of hypocalcemia include:. Twitching in your hands, face, and feet.. Numbness.. Tingling.. Depression.. Memory loss.. Scaly skin.. Changes in the nails.. Rough hair texture.. Which assessment would indicate of hypocalcemia?Ionized calcium is the definitive method for diagnosing hypocalcemia. A serum calcium level less than 8.5 mg/dL or an ionized calcium level less than 1.0 mmol/L is considered hypocalcemia. Analysis for the ionized calcium level must be performed rapidly with whole blood to avoid changes in pH and anion chelation.
What does hypocalcemia look like?The calcium level in blood can be moderately low without causing any symptoms. If levels of calcium are low for long periods, people may develop dry scaly skin, brittle nails, and coarse hair. Muscle cramps involving the back and legs are common.
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